Feasibility and Reliability of SmartWatch to Obtain 3-Lead Electrocardiogram Recordings

Some of the recently released smartwatch products feature a single-lead electrocardiogram (ECG) recording capability. The reliability of obtaining 3-lead ECG with smartwatches is yet to be confirmed in a large study. This study aimed to assess the feasibility and reliability of smartwatch to obtain 3-lead ECG recordings, the classical Einthoven ECG leads I-III compared to standard ECG. To record lead I, the watch was worn on the left wrist and the right index finger was placed on the digital crown for 30 s. For lead II, the watch was placed on the lower abdomen and the right index finger was placed on the digital crown for 30 s. For lead III, the same process was repeated with the left index finger. Spearman correlation and Bland-Altman tests were used for data analysis. A total of 300 smartwatch ECG tracings were successfully obtained. ECG waves’ characteristics of all three leads obtained from the smartwatch had a similar duration, amplitude, and polarity compared to standard ECG. The results of this study suggested that the examined smartwatch (Apple Watch Series 4) could obtain 3-lead ECG tracings, including Einthoven leads I, II, and III by placing the smartwatch on the described positions.

[1]  E. W. Hancock,et al.  AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the , 2009, Journal of the American College of Cardiology.

[2]  Alexander Samol,et al.  Single-Lead ECG Recordings Including Einthoven and Wilson Leads by a Smartwatch: A New Era of Patient Directed Early ECG Differential Diagnosis of Cardiac Diseases? , 2019, Sensors.

[3]  Alexander Samol,et al.  Recording of Bipolar Multichannel ECGs by a Smartwatch: Modern ECG Diagnostic 100 Years after Einthoven , 2019, Sensors.

[4]  Carol Elsakr,et al.  Apple Watch, Wearables, and Heart Rhythm: where do we stand? , 2019, Annals of translational medicine.

[5]  A. Wilde,et al.  The Measurement of the QT Interval , 2014, Current cardiology reviews.

[6]  Harry W Severance,et al.  Smartphone ECG for evaluation of STEMI: results of the ST LEUIS Pilot Study. , 2015, Journal of electrocardiology.

[7]  Alexander Valys,et al.  Smartwatch Performance for the Detection and Quantification of Atrial Fibrillation. , 2019, Circulation. Arrhythmia and electrophysiology.

[8]  Marco V Perez,et al.  Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. , 2019, The New England journal of medicine.

[9]  Daniel Hayoz,et al.  Handheld ECG Tracking of in-hOspital Atrial Fibrillation The HECTO-AF trial Clinical Study Protocol , 2019, Trials.

[10]  Beyond the early adopter: The smartwatch ECG goes mainstream. , 2019, Trends in cardiovascular medicine.

[11]  Nino Isakadze,et al.  How useful is the smartwatch ECG? , 2019, Trends in cardiovascular medicine.

[12]  Agam Bansal,et al.  Portable out‐of‐hospital electrocardiography: A review of current technologies , 2018, Journal of arrhythmia.

[13]  Richard G Trohman,et al.  Single-lead portable ECG devices: Perceptions and clinical accuracy compared to conventional cardiac monitoring. , 2015, Journal of electrocardiology.

[14]  M. AlGhatrif,et al.  A brief review: history to understand fundamentals of electrocardiography , 2012, Journal of community hospital internal medicine perspectives.

[15]  D. Frisch.  A Novel Technique to Expand the Electrocardiographic Recording Capability from an Apple Watch. , 2019, The American journal of medicine.

[16]  C. Reid,et al.  Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis , 2018, Heart.

[17]  Shuyan Li,et al.  Mobile Photoplethysmographic Technology to Detect Atrial Fibrillation , 2019, Journal of the American College of Cardiology.

[18]  E. W. Hancock,et al.  AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the , 2009, Circulation.

[20]  M. Á. Cobos Gil.  Standard and Precordial Leads Obtained With an Apple Watch , 2019, Annals of Internal Medicine.

[21]  Michel Haïssaguerre,et al.  Validating QT-Interval Measurement Using the Apple Watch ECG to Enable Remote Monitoring During the COVID-19 Pandemic , 2020, Circulation.

[22]  T. Coleman,et al.  Accuracy of methods for diagnosing atrial fibrillation using 12-lead ECG: A systematic review and meta-analysis. , 2015, International journal of cardiology.

[23]  A. Nigolian,et al.  Diagnostic accuracy of multi-lead ECGs obtained using a pocket-sized bipolar handheld event recorder. , 2017, Journal of electrocardiology.

[24]  P. Vandervoort,et al.  Atrial fibrillation screening with photo-plethysmography through a smartphone camera. , 2019, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[25]  G. Hindricks,et al.  European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population , 2020, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[26]  Cesar Avila.  Novel Use of Apple Watch 4 to Obtain 3-Lead Electrocardiogram and Detect Cardiac Ischemia. , 2019, The Permanente journal.

[27]  K. Rajakariar,et al.  Modified positioning of a smartphone based single-lead electrocardiogram device improves detection of atrial flutter. , 2018, Journal of electrocardiology.

[28]  A. Koshy,et al.  Wearable devices for cardiac arrhythmia detection: a new contender? , 2019, Internal medicine journal.

[29]  P. Macfarlane,et al.  Recommendations for standardization and specifications in automated electrocardiography: bandwidth and digital signal processing. A report for health professionals by an ad hoc writing group of the Committee on Electrocardiography and Cardiac Electrophysiology of the Council on Clinical Cardiology, , 1990, Circulation.

[30]  T. Münzel,et al.  Apple Watch detecting coronary ischaemia during chest pain episodes or an apple a day may keep myocardial infarction away , 2020, European heart journal.

[31]  J. Pevnick,et al.  Wearable technology for cardiology: An update and framework for the future. , 2018, Trends in cardiovascular medicine.

[32]  R. Giugliano,et al.  Impact of Time of Presentation on Process Performance and Outcomes in ST-Segment–Elevation Myocardial Infarction: A Report From the American Heart Association: Mission Lifeline Program , 2014, Circulation. Cardiovascular quality and outcomes.

[33]  A. Baranchuk,et al.  The Current State of Mobile Phone Apps for Monitoring Heart Rate, Heart Rate Variability, and Atrial Fibrillation: Narrative Review , 2019, JMIR mHealth and uHealth.